Since mid-2006 violence has dramatically increased in scale and intensity in the northern parts of Central African Republic–with grave consequences for the civilians who are caught in the crossfire of a number of armed groups. More recently, the north-eastern province of Vakaga has also been the site of intense fighting. MSF was one of the first international aid group to be active in this very remote region bordering Chad and Sudan. An interview with MSF's outgoing Head of Mission Heinz Henghuber.

We discovered more than 200 houses which have been burned.

– Heinz Henghuber

How has the situation evolved at the end of last year?

At the end of October, a newly formed armed group started to take control of several key towns in the Vakaga province. In December, it was announced that the government had recaptured all areas. The problem was that nobody had any information about the humanitarian situation. Attempts by humanitarian organizations to assess the needs of the population in the region were blocked by the government for over a month. In the middle of December, MSF was finally granted access to the people.

What is the humanitarian situation like?

The civilians in Vakaga are trapped in the middle of the conflict. They are suspected to support one side or the other. Violence between armed groups has led to the pillaging and burning of entire villages. We discovered more than 200 houses which have been burned. The people fear reprisals from the armed groups. The majority of the population has been forced to flee their village and about 10,000 to 15,000 people are hiding in the forest–where they attempt to survive in the most primitive living conditions.

For most of the population–estimated at 35,000 to 55,000 for the whole province–there is no access to health care whatsoever. Health posts are abandoned, most of the few medical workers have fled the area, and the few medical supplies that would normally have been sent to Vakaga have not reached most parts of the province since the outbreak of fighting.

How is MSF reacting?

As a first short term response, a mobile medical team visits about half a dozen locations in and around the provincial capital Birao and is treating up to 100 patients per day. The main health problem is malaria, which is particularly prevalent as the wet season lasts up to ten month in the region. But the team also comes across acute respiratory infections and diarrheal diseases, indicators of the bad living conditions for people. We also distributed emergency relief items to displaced people: blankets as it is quite cold there at night, mosquito nets impregnated with repellant to help people protect themselves from malaria, plastic sheeting and soap to improve the shelter and hygiene of those who live in the forest.

Apart from the assistance in and around the provincial capital Birao, we are currently expanding our activities to the area of Gordil, about 200 kilometers or a ten-hour drive to the west. Relief items are being distributed to the population who are hiding in the bush in this area, and a mobile team is treating those in need of medical care.

Vakaga is partly government-controlled, partly rebel-held. What does that mean for the people and MSF's work?

As I said, people are caught in the middle of the conflict. Even if they do not take sides they may be suspected of supporting either the government or the rebels. In a way, MSF faces the same suspicion. It is very difficult to persuade everyone that we are neither on one side nor the other, and to keep being seen as neutral, which is our main basis for access to the population in need. We cannot do our work in safety if this is not understood.

MSF teams therefore reiterates time and again to all sides–village chiefs, representatives of armed groups, government officials, local population–that MSF assists the most vulnerable first, regardless of their political, religious or ethnic affiliation, and that we help people purely on the basis of medical need. In the end it is our neutral and impartial action that counts. So, a good medical program is our best protection.